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C e

L-Z

SevenHills

HOSPITAL

IN PATIENT - CREDIT FINAL BILL

To

V1PUL MEDCORP TPA, V1PUL MEDCORP PVT. LTD. CLAIMS DEPARTMENT B14. WADALA UDYOG BHAVAN, WADALA (W), MUMBAI-400031 MUMBALMAHARASHTRA INDIA-400 031

Bill No:

BIPR1506010006

Bill Date:

01/06/2015 11:47

UHID:

MCH2400076

Patient No:

1150527006

Bed No:

6118

111111111111111111111111111111111111111

111111111111111111111111111111111

Patient Name: ANANYA MOOKHERJEE

Pay Type:

CREDIT

Age(Sex):

30Y 5M (F)

Bill Type:

NORMAL

Sponsor:

VIPUL MEDCORP TPA

Dr Name

DR.CHITWAN DUBEY

Employee No:

Relation With Patient:

Emp Name:

Ref.Lr.No -- Date:

Jmission Date:

27/05/2015 05:01

Discharge Date:

01/06/2015 11:45

Sr No

Payments

Amount(Rs.)

1

PAYMENT AND

41,379.00

Emp1O`Jec

f ra wL

,

Sigcet'

pate ------

Sr No

Account Heads

1

DOCTOR CONSULTATION

2

MISCELLANEOUS GENERAL

3

REGISTRATION

4

PROCEDURES

LAB CHARGES

ROOM RENT

PHARMACY

8

PACKAGES

9

DIET

4t6huiet

Ninety-One Thousand Three Hundred Seventy-Nine And Thirty-Nine Poise only

Rupees:

Net Payable In Words: (Rupees)Fifty Thousand only

Checked By:

Prepared By:

NOTE:

For SEVENH

Autho

LTH CARE PVT LTD,

Total Amount (Rs.)

Net Amount (Rs.)

6,550.00

6,550.00

170.00

170.00

240.00

240.00

8,940.00

8,940.00

680.00

680.00

3,000.00

3,000.00

4,294.39

4,294.39

66,000.00

66,000.00

1,505.00

1,505.00

Billed Amount(Rs):(+)

91,379.39

Collected Amount(Rs):(-)

41,379.00

Total Amount(Rs):

50,000.39

Round Amount(Rs):

-0.39

Net Payable(Fis):

50,000.00

,frovi

Verified the above arid found correct

L:—

Attendant/Patient Signature

I. Any correspondence ojtis bill should only be addressed to the Director, SEVENHILLS HEALTH CARE PVT LTD,MUMBAI.

2. The Cheque/OD shoul&be issued in favour of SEVENHILLS HEALTH CARE PVT LTD,MUMBAI. Our PAN No. is:

3. The disputes on this bills, if any shall be under the jurisdiction of MUMBAI only.

4. Acknowledgements/Signatures are as per the individual / seperate bills enclosed here with bearing page no. from

0

Caen.

.4•01.

Onk•i•et.igra

SevenHills HealthCity

Marol Maroshi Road, Andheri (East), Mumbal - 400 059. Ph.: 022-6767 6767 www.sevenhillshospital.com

to

tatAMENTIMS

HOSPITAL

UHID No

:

MCH2400076

UP No

:1150527006

Patient Name

:ANANYA MOOKHERJEE

Age ( Sex )

:30Y ( Female )

Admission Date

:27/05/2015 05:01

Discharge On

:01/06/2015

Bed No

:6118 (L6 B8 SINGLE ROOMS)

Discharge Type :NORMAL

Sponsor

: VIPUL MEDCORP

Clinical Dept

: OBSTETRICS I GYNAECOLOGY

DIAGNOSIS

:

SUPERVISION OF NORMAL PREGNANCY - Z34 PRIMI WITH 39.2 WK WITH LP WITH HYPOTHYROIDISM WITH IMPAIRED GTT FIBROID' UTERUS

CONSULTANT

DR.CHITVVAN DUBEY'

REASON FOR ADMISSION (Salient History apresenting complaints)

DIAGNOSIS-30 YR OLD ML 2 AND 1/2 YR SPONTANIOUSLY CONCEIVED PRIMIGRAVIDA WITH 39.2 WKS WITH LABOUR PAINS WITH HYPOTHYROIDISM WITH IMPAIRED GTT CHIEF COMPLAIN- H/0 AMENORRHOEA SINCE 9 MONTH C/O PAIN ABDOMEN SINCE 2 HR PRESENT ILLNESS- PARIENT IS ADMITTED WITH C/O PAIN IN ABDOMEN AND BLEEDING PV SINCE 1-2 HR FOLLLO WING AMENORRHOEA OF 9 MONTHS. PATIENT HAS C/O PAIN ABDOMEN RAIATING FROM BACK TO THIGHS. SHE ALSO HAS C/O BLEEDING PV. THERE IS NO C/O LPV AND DECREASE FETAL MOVEMENT. REGISTERED,TT IMMUNISED,REGULAR CHECK UP H/0 FLUVIR PROPHYLAXIS AT 30 WK

M/H-

LMP-25-08-2015

EDD-01-06-2015

PREVIOUS MENSTRUAL CYCLE-3-4DAY/30 DAYS/AVG BLEEDING 0/H - ML-2 AND 1/2 YR

PRIMIGRAVIDA P/H-MEDICAL ILLNESS-H/0 HYPOTHYROIDISM SURICA ILLNESS- NO SIGNIFICANT HISTORY TREATMENT HISTORY-ON THYRONORM 12.5 MCG F/H-NO SIGNIFICANT HISTORY PERSONNEL HISTORY-ADDICTION- NONE CONTRACEPTIVE METHOD-NONE BLADDER AND BOWEL HABIT-NORMAL

beemiell.ne NflL

SevenHills HealthCity

Marol Maroshi Road, Andheri (East), Mumbai - 400 059. Ph.: 022-6767 6767 www.sevenhillshospital.com

re. 7

UHID No

Patient Name

: MCH2400075ft—

:ANANYA M

yen11))

r„

EXAMINATION FINDINGS (Salient genPal and gyeemic exam A results)* Li

: 1150527006 :30Y ( Female )

0/E-

CONCIOUS ORIENTED T-AFEB

P-76/M

BP-120/70MMHG

RR-20/M

PALLOR-ABS OEDEMA-ABS ICTERUS-ABS CVS-S1S2 PRESENT NO MURMUR

RESP-B/L E AIR ENTRY NO CREPS AND RONCHI

P/A-

FULL TERM VERTEX

HEAD-5/5

LOA FHR-146/M REGULAR UTERUS IRRITABLE P/S-NO LEAKING NO BLEEDING PN-CERVICAL OS CLOSED,CEVIX UNEFFACED, POSTERIOR, SHOW PRESENT HEAD STATION AT -3,PELVIS ADEQUATE

COURSE OF MANAGEMENT (Salient Medications, Surgery performed, Complications, if any, during marIPMEEPLAKEVIVACUUM ASSISTED VAGINAL DELIVERY WITH MEDIOLATERAL EPISIOTOMY ON

28/05/15

FEMALE BABY, WT- 3.175 KG ON 28/05/15 AT 10:45AM PT IN LITHOTMY POSITION. BLADDER EMPTIED WITH GOOD UTERINE CONTRACTIONS AND FULL DILATATION OF CERVIX PT ASKED TO BEAR DOWN VACUUM APPLIED IN/0 POOR MATERNAL BEARING DOWN EFFORTS BABY DELIVERED BY VX, CRIED IMMEDIATELY AFTER BIRTH CORD CLAMPED AND CUT AND BABY HANDED OVER TO NEONATOLOGIST PLACENTA AND MEMBRANES DELIVERED OUT COMPLETELY UT WELL CONTRACTED, NO E/O TEAR CERVIX EXPLORED,NO E/O TEAR EPISIOTIMY SUTURED IN LAYERS WITH 2-0 VICRYL PT WITHSTOOD PROCEDURE WELL

SIGNIFICANT INVESTIGATIONS DURING STAY WITH PATIENT

PATIENTS CONDITION AT THE TIME OF DISCHARGE (Brief notes on clinical condition GC- FAIR

PR-80/M

BP-110/70MMHG

CHEST-B/L CLEAR CVS-S1S2 NORMAL P/A- SOFT

Oira,0••

1.211141111.

Kalil

0••••••3•1471*

SevenHills HealthCity Marol Maroshi Road, Andheri (East), Mumbai - 400 059. Ph.: 022-6767 6767 www.sevenhillshospital.com

Pogo 2 of 4

L-Z

SevenHills

HOSPITAL

UHIO No

MCH2400076

IP No

:1150527006

Patient Name

:ANANYA MOOKHERJEE

Age ( Sex )

:30Y ( Female )

LIE- LOCHIA HEALTHY EPI HEALTHY PASSED URINE PASSED MOTION

MANAGEMENT PLAN ON DISCHARGE " ON ORAL MEDICATION

DISCHARGE MEDICATIONS (advice on medication till next review)"

T

CEFTUM 500 MG 1BD

T

RANTAC 150 MG 1BD

T

COMBIFLAM 1BD

T

CHYMORAL FORTE 1BD

STP CREMAFFIN 30 ML SOS ALL MEDICATION FOR 5 DAYS

FOOD & DRUG INTERACTIONS " 1.Anti-histaminics- alcohol to be avoided 2.Analgesics/Antipyretics- take along with food. Avoid alcohol 3.NSAIDs- To be taken with food or milk. Avoid alcohol 4.Narcotic Analgesics-alcohol to be avoided 5.Bronchodilators- avoid foods and drinks that have caffeine. Avoid alcohol 6.Anticoagulants- take on empty stomach. Avoid cranberry juices/products % alcohol. 7.Diuretics- to be taken with food, avoid potassium rich foods. 8.Statins- to be taken with evening meal. Avoid alcohol 9.Beta blockers- take with meal or right after meal, 10.ACE Inhibitors- take one hour before meals, avoid potassium rich foods.

FOLLOW-UP INSTRUCTIONS * F/U AFTER 10 DAYS WITH PRIOR APPOINTMENT

ALLERGY" NO ANY ALLERGIC REACTION FOUND TO ANY DRUGS

CONTACT NUMBER IN CASE OF EMERGENCY 1 .PAIN

2.BLEEDING

 

3.FEVER

4.

In

case of above complaints, please seek emergency attention. Please contaaloriftimediate *

assistance. SevenHills Hospital - CM0 (Emergency Dept) Ph: 022 - 67676767 (Ext 71583, 71554)h

Oseell•

N• • L

11.11,144119

0••••••t•••714

SevenHills HealthCity

Marol Maroshi Road, Andheri (East), Mumbai - 400 059. Ph.: 022-6767 6767 www.sevenhillshospital.com

Page 3 of 4

Com

UHID No

Patient Name :ANANYA

: MCH24000

ma) Mire

"

n 11110

S

Age ( Sex )

I T

A

L

:1150527006

:30Y( Female)

.12_10

DR. PREETI

Authorized On: 32115/2015 14:31

NAOIL

eniMmilem

End of Discharge Summary

SevenHills HealthCity

Marol Maroshi Road, Andheri (East), Mumbal - 400 059. - Ph.: 022-6767 6767 www.sevenhillshospital.com

Page 4 of 4

HOC

SevenHills

HOSPITAL

Covering Letter

No:SHH/AcctNIPUL MEDCORP TPA

01/06/2015

Date:

To Vipul Medcorp Pvt. Ltd. Claims Department B14. Wadala Udyog Bhavan, Wadala (W), Mumbai-400031 MUMBAI,MAHARASHTRA INDIA-400 031 Ph No:9833353064

Dear Sir,

Sub: Medical Treatment provided to ANANYA MOOKHERJEE

Ref: Your Letter No. Dated: ,

The above patient was admitted in our hospital and was provided with needed medical treatment. A bill of Rs:50000.00/-(Rupees Fifty Thousand only) raised towards our services. The bill details are enclosed herewith for your kind perusal

,

Date Of Admission Date of Discharge

Bill No

01/06/2015

We request your good self to kindly arrange payment at the earliest.

Thanking you and assuring you of our best services at all times.

27/05/2015

BIPR1506010006

Yckefthf II , HealthCare Pvt Ltd.

ffiery

_Kt

NEnClosuras,"

Amount (Rs.)

91,379.39

Marol Maroshi Road,Andheri(E),Mumbai-59.Ph : 022 -67676767.

www.sevenhillshospital.com E-mail :info@sevenhillshospital.com

,

SEVEN HILLS 1-40SPITAL PVT LTD.

DATE

NAME OF THE PATIENT

IP NO

:- 01-06-2015

:- ANANYA MOOKHERJEE ,

: - 1150527006

_

 

DATE OF ADMISSION

:- 27/05/15 94F21

 

DATE OF ADMISSION

:-

06/15/10:19:01

 

i

 

DETAIL'S

/AMOUNT

Final Bill Amount

1

91379.00

 

I

 

Final Approved Amount

-rom TPA

 

50000.00

Total Deposit paid by patient

5000.00

(Difference of Sanctioned attioutte'and bill 'aittointeLAi p:er Final App \

1

41379.00

 

Security Deposit 10% (AS PER HOSPITAL POLICy )

5000.00

AMOUNT TO BE COLLECTED TO PATIE T

41379.00

Security Deposit will be refundable when the c

Any shortfall in the claim settlement will from TPA will be ecovered f ii the ecurity D posit

# Security Deposit Refund Through NEFT ONLY

For Security Deposit Kindly Call Collection Dept :- Mrs. UCHIT & MR. A IPAL

s sett d by TPA 0 Insu ance Comp y

Landline 022-67676767 ( EXT NO: -,71476\

) Email id :- mumbai.collectioneseve llshospital corn

*Kindly Mention the Belo Security deposit in Favour of Name of Account Holder:

Name of the Bank

'r

14 Batik Account No Branch Name

DSC code

if Name of the Payee is different than the Patient Name ( Tick ) the reason

1. P.tieiat does flat have a Bank kiccOlunt.( ) 2. Patient is ininor ( ) 3. Patient is an NRI / Outstation Patient( )

Vipul MedCo ' IIPA Private Limited

515, Udyog Vihar,IPhase 5, Gurgaon, Haryana Phones: +91 0124 4833900, 4699600 Fax: +91-124-4699611-12,4308211,2438276 Toll Free : 1800 18011 66 and 1800 18011 77

Authorization letter for treatment and guarantee of payment

Date: 16-May, 2015 To, SEVENHILLS HEALTHCARE PRIVATE LIMITED MAROL MAROSHI ROAD ANDHERI EAST MUMBAI MAHARASHTRA Pin: 400059

Authorisation No : 04A01C0516926 Claim No: 1601C2195 File No : 16CB0101C0628

Name of :tic iary/Patient 1poliey No 'ID No

: MS. ANANYA MOOKHERJEE

: 212800/48/2015/34 field by:411# CONTJNIILIM INDIA !PRIVATE LIMITED

: 0410010017999426

Reason For Hospitalisation : OLITICOME OF DELIVERY Secondly Disease

Procedure Medical Consultant

. 1) NORMAL DELIVERY

Guarantee of payment uptoRs. 50000.00 [RUPEES FIFTY THOUSAND ONLY] With Following Capping on Cost Heads:

Spe1 cial:Isitite: REVERT IN CASE OF LACS

!SpECIAL NOTE:

• Please ensure the documents should be submitted to Vipul Medcorp TPA.Pvt Ltd.within 7 days of the discharge of the

beneficiary. Due to non compliance of this provision the claim shall be marked as "NO CLAIM" as per instructions from the insurers.

• 'Service Taxhas been withdrawn on service renderid yvef 01.05.2011 as per Govt. Notification No. 30 dated 25.04.2011.

IEJOSPETAL TO PLEASE NOTE: '1

 

I

;

I 10

• •

1

'Amounts exceeding a total of Ri. 50000.00 RUPEES hiTY THOUSAND ONLY] will require further authorization. I

• The hospital must collect the exOess amount (over th!e authorilation amount) directly from the beneficiary at the time of admission prior to Discharge fromthe Hospital, as pqrliospital Rules and.Regulations (NOT APPLICABLE FOR PACKAGE RATES).

This authorisation letter is valid for admission between 31-May, 2015 and 05-Jun, 2015 Note: In Case of Stay is Beyond3 Days, Mndly Send the detailed Case Summary.

EXCLUSIONS: (Expenses for the following may please be recovered from the concerned member MS. ANANYA MOOICHERJEE)

• ,

Registration Fee, Admission Fee, Surcharges, Ambulance Charges, Telephone Expenses, Attendant's stay, Washing Charges, Private Nurses, Food, Nursery Charges, Misc expenditure and other expenditure which are not related to the

eLk

7-",

SevenHills

HOSPITAL

SevenHills HealthCity

Marol Maroshi Road, Andheri (East), Mumbal - 400 059. Ph.: 022-6767 6767 www.sevenhillshospital.com

Vipul MedCorp TPA Pvt Ltd.

We** Haaikang Sara DETAI1S OF THETHIRD PARTY ADMINISTRATOR

REQUEST FOR CASHLESS HOSPITALISATION FOR MEDICAL INSURANCE POLICY

aJ Name Of TPA/ Instance company: VIPHL MEDCORP TPA PVT LTD.

b)lbll free phone number:

C) FAX

1800 102 7477

0124-4699611-12 4308211

TO EIC FILLED BY THE INSURED / PATIENT

sithmitawa.pau.nu

ANANye

MOO kT HERseE

Q.

b) Derider: Rale /MAIN e)Age: %an 3 0 Mocht 0 4 41 Date of birth:

.7/L 211; ; 11 clailluri flioniolt

cl

f) Cantonal:nit:yr of attending relative:

133

33 5 S 0 6

4

g) Insured Id Card numben o

4tooto .0:1

h) Polley number/Name Of corporate:

13 • A • COAT tts1 R. U H

EN DIA Employee ID:

9_ 0 1

q q

3 8 la 0

9 i Q 6

9

I) Cum:nily do you Nave any other

Give details

/ lie-11th Insurance: '

yet . No Company Name:

y

k) Do roc, have i family physician: tea Ne I) HMO nub. family physiden

TMContact number, it any:

(PLEASE COMPLETE DECIARATION ON THE REVERSE SIDEOF This FORM)

TO BE FILLED BY THE TREATING DOCTOR / HOSPITAL

a)

Ii

Nam of the treating doctor: C H

TH-

n a

y 056,y

Nature ol ILLNESS / OHM, with presenting complaints

"Dv rot 3 a, 0.71.8 ?Tern( y

;

b) Conlon nurnben

d )Rolevant clinical findings:

e) Duration of the present ailment

Ana I. Date of nro rontultalion

Katmai; f ir

pYhnL

11. Past history of present aliment linty:

EPtroposed line of treauntin

Macill Maar_end

Le‹1 °.---4111Mearigtmeni

intamwecare

L ICO 10 Code:

Invtilikettun

kolb.41kitallUr keNuntit

b) lf Ineettigailan /or Medical PLinegement provide details

!Inutile ardrutarlmlnliglratIod:

 

Rind, name of surgery

ft

If other treatment$ provide details

1)

In citse otarcident:

L6e-6/ go,,,,„t

p

I/bill RTA: . yes

II) Dale 011ITIOITI

LbCD 10 PCS Code:

It) How did Inlury occur:

WI Reported to Police:

v)Iniury/DIseasecaiteed due to subeianer abuse/alcohol consumption • We

if) Test conducted to establish thit :

1)

In eme cd Alatemlip

1

P

0

A

Date

of Delivery: a / /

0

61 r

AM

I lie

NI, IV) FIR No:

fit Yes attach reports)

Details of the patient admitted

Mandatom: Past Maim of any chronic

II ri.ilnre (mount net)

a) Date of admission:

3 go 5 a, i. j

b)TIme:

4) Is Chit nntmergenty/a pi/tonic, host I tone:sum trent?

Darrirmy

d) rspectird no. °Nays stay In hotpltsh

5

nap el Rom TYPe

tJ PerDay Room Rent *Nursing al Service Charges • Patient', Dice

illaperted cosi for Investigation « diem:es-11m t½e YhtehkAdra-; rqs S 66 o

is) ICH Charges: 1) OTatarget

l)

Rs

Rs

Its

LSI. (fir P6 PO.A.k.lad,/,.

Proles- Am:al fees Surgeon • Anesthetist Pees • conothati on (barges RS

Diabetes

Heart Disease

 

Ilypertension

PeClInAm

Hype:I-Opt:le:Was

OsteoarthrItls

Asamm/aWD/BromM

Gower

Sl jt

11;1,,505

fthinCigt

LID

OCA

re,. BO p e e , 5t)

aGedi

Any HIV or gRiftwAtVaiiii nti.

Aftr"

hproy -*tat

:31,1400

6/1/2015

II' final billing 43

Patient Name

Patient No

-- .—

EMR No

Category

Ago ( Gender )

Employee Id

Employee Name

Patient Relation

ANANYA MOOKIIEFUEE

150527006

MCI42400070

SPONSOR

30Y 5M 013(F)

Package: (VACCUN DELIVERY) I Duration (3)

Sponsor/Third Party Information

Third Party Name

Payments ft Receipts

Stio

Services / Description

11 PAYMENT AND RERINI35

Patient Transaction Details

 

BIliDate

01/06/2015 10:1001 .

.

Registration Date

27/05/2015 05:01:21

Patient Type

IP

-

.

.

Sponsor

VIPUL MEOCORP TPA

 

Bill Type

NORMAL

--

Payment Type

Cash & Credit

Start 8 End Dato

27/05/2015 05:01:21 /201510:1901

From (28/05/2015) ITo (30/05/2015) I Limit (66,000.00)

 

Analysis

Sponsor Name

VIPUL MEDC RP TPA

Sponsor C egory TPA

 
 

Service

Amount Rs.

Billed P 'Ilion

 

5000.00!

SNo

'vices / Description

Discount

Amount Rs

 

Total

5,000.00

1

I

DI

1 50 .00

 

2

1 -, t

iSTRATII

24D00

3

,

LA cuARaES

 

680.00

 

66,000.00

 

MISC: LAMEOUS GD/

j

— 170.00

 

6

DOCT • - CONSULTATION

6.550.00

7

i

PROC:f 'ia.

8,940.00'

8

!. ROOM -.:

000.00

 

9

I

PHARMAC

4

39

 

Total

913

9

 

Unbilled Position

 
 

1

 

Total BIll Amount Rs

I

91,379.391

Payment and Refunds Rs

I

5 000.001'

Net Amount Rs

I

86,379.3M

http://10.129.41.194:9999/Medpro4/patientBilling.do?subAction=patientBillDetailsInit&ID=1150527006

1/2

SevenHills

90 8 PITAL

Patient No: 1150527006

UHID:

MCH2400076 Patient Name:

IN-Patient Bill Breakup

ANANYA MOOKHERJEE Age(Sex) 30Y 5M OD ( FEMALE )

FinalBill No: BIPR1506010006 Bill Date:

01-06-2015

Sponsor:

VIPUL MEDCORP TPA

Pay Type: CREDIT

 

Account Head :

DOCTOR CONSULTATION

Bed No - Type:

6118 - SINGLE

Amount(Rs.)• 6,550.00

 
 

SNo

BIII No

Ser.Prov.

Dr Name

Service/Item

I No's I Amount I Discount I Total(Rs.) )

Bill Status:

ACTIVE

 

1 5015052701248NA(SER02817)

27/05/2015

CHITWAN DUBEY

MD /MS CONSULTATION CHARGES

850.00

0.00

850.00

2 5015052700693NA(SER02817)

27/05/2015

CHITWAN DUBEY

MD /MS CONSULTATION CHARGES

850.00

0.00

850.00

3 S015052700859NA(SER04152)

27/05/2015

MEDICAL OFFICER

RMO CHARGES

200.00

0.00

200.00

(

27/0512015

 

1.900.00

4

S015052901059PA(SER02817)

29/05/2015

ZINAL UNADKAT

MD /MS CONSULTATION CHARGES

850.00

0.00

850.00

(

29/05/2015

 

850.00

5

5015053000452PA(5ER02617)

30/05/2015

SWAT! TEMKAR

MD /MS CONSULTATION CHARGES

850.00

0.00

860.00

30/05/2015

 

ssozo

6 S015053100654PA(SER02817)

31/05/2015

CHITWAN DUBEY

MD /MS CONSULTATION CHARGES

850.00

0.00

850.00

7 S015053100947PA(5ER02817)

31/05/2015

CHITWAN DUBEY

MD /MS CONSULTATION CHARGES

850.00

0.00

850.00

8 S015053100091PA(5ER04152)

31/05/2015

MEDICAL OFFICER

RMO CHARGES

200.00

0.00

200.00

31/05/2015

 

1,900.00

9 S015053101019NA(5ER02817)

01/06/2015

CHITWAN DUBEY

MD (MS CONSULTATION CHARGES

850.00

0.00

850.00

10 S015053101020NA(5ER04152)

01/06/2015

MEDICAL OFFICER

RMO CHARGES

200.00

0.00

200.00

01/0612015

 

1,050.00 )

 

APPROVED TOTAL(Rs.)

6,550.00

NET AMOUNT(Rs.) :

6,550.00

Account Head :

MISCELLANEOUS GENERAL

Bed No - Type:

6118 -SINGLE

AmounaRs ).

170.00

 

SNo I

Bill No

I Ser.Prov. I

Dr Name

Service/Item

I Ws I Amount I Discount I Total(Rs.)

Bill Status:

ACTIVE

1

5015052700270NA(SER03342) 27/05/2015 MEDICAL OFFICER

SURGICAL SHAVING / HEAD SHAVING

1

170.00

0.00

170.00

27/05/2015

 

170.00)

 

APPROVED TOTAL(Rs.) :

 

170.00

NET AMOUNT(Rs.) :

170.00

Account Head :

REGISTRATION

 

Bed No - Type:

6118 - SINGLE

Amount(Rs.): 240.00

SNo

BIII No

Ser.Prov.

I

Dr Name

Service/Item

I No's I Amount I Discount I Total(Rs.)

BM Status:

ACTIVE

1

TICW115052700601(SER02589) 27/05/2015 CHITWAN DUBEY

ADMISSION CHARGES

 

1

240.00

0.00

240.00

27/05/2015

 

240.00)

 

APPROVED TOTAL(Rs.) :

 

240.00

NET AMOUNT(Rs.) :

 

240E0

Account Head :

PROCEDURES

 

Bed No. Type:

6118- SINGLE

Amount(Rs )

8,940.00

SNo

13111 No

Ser.Prov,

Dr Name

Service/Item

I No's I Amount I Discount I Total(Rs.) )

Note: MI the Amounts are Show, In Rupees

Service/item Count

12

Page Total(Rs.):

6,960.00

Page 1 of

5

SevenHills

H

08P IT A

I

Patient No: 1150527006

FinalBill No: BIPR1506010006 Bill Date:

UHID:

(Account Head :

PROCEDURES

 

SNo

Bill No

1 Ser.Prov.

Bill Status:

ACTIVE

 

S015052900918NA(SER05724)

 

27/05/2015

2 6015052700274NA(5ER02883)

27/05/2015

3 5015052701170NA(SER04951)

27/05/2015

4 S015052700268NA(SER04951)

27/05/2015

5 S015052700269NA(SER02884)

27/05/2015

6 6015052700996NA(SER02906)

27/05/2015

7 5015052700273NA(SER02906)

27/05/2015

8 S015052701367NA(SER04951)

27/05/2015

i 27/05/2015

 
 

9

S015052800418NA(5ER02883)

 

28/05/2015

(

28/05/2015

Account Head :

LAB CHARGES

(

SNo

Bill No

1

Ser.Prov.

BIII Status:

ACTIVE

MCH2400076 Patient Name:

IN-Patient Bill Breakup

ANANYA MOOKHERJEE Age(Sex): 30Y 5M OD (F)

01-06-2015

Sponsor:

VIPUL MEDCORP TPA

Pay Type: CREDIT

 

Bed No - Type:

6118 - SINGLE

Amount(Rs.):

8,940.00

Dr Name

Service/Item

I No's 1 Amount

I Discount 1 Total(Rs.)

CHITWAN DUBEY

CHITWAN DUBEY

LR RECOVERY ROOM CHARGES PER DAY

1

5,200.00

0.00

5,200.00

HOT - PROCEDURE CHARGE

1

200.00

0.00

200.00

MEDICAL OFFICER

NEONATAL SENSORY TEST (NST)

1

920.00

0.00

920.00

MEDICAL OFFICER

MEDICAL OFFICER

MEDICAL OFFICER

NEONATAL SENSORY TEST (NST)

1

920.00

0.00

920.00

I. V. INJECTION / CANNULLA INSERTION -

1

300.00

0.00

300.00

PROCEDURE CHARGE SIMPLE ENEMA - PROCEDURE

1

160.00

0.00

160.09

MEDICAL OFFICER

SIMPLE ENEMA - PROCEDURE

1

160.00

0.00

160.00

MEDICAL OFFICER

NEONATAL SENSORY TEST (NST)

1

920.00

0.00

920.00

 

8780.00)

CHITWAN DUBEY

HOT - PROCEDURE CHARGE

 

160.00

0.00

160.00

 

160.00

 

APPROVED TOTAL(Re.) :

 

8,940.00

NET AMOUNT(Rs.) :

8,940.00

Bed No - Type:

6118 • SINGLE

Amount(Rs ):

680.00

Dr Name

Service/Item

1 No's 1

Amount

1 Discount 1 Total(Rs.)

1 L015052700043NA(SER00133) 27/05/2015 MEDICAL OFFICER

COMPLETE BLOOD COUNT (CBC)

480.00

0.00

480.00

2 L015052700043NA(5ER02560) 27/05/2015 MEDICAL OFFICER

BLOOD GROUPING

120.00

0.00

120.00

3 L015052700043NA(5ER02565) 27/05/2015 MEDICAL OFFICER

CROSS MATCHING

80.00

0.00

80.00

27/05/2015

680.00

 

APPROVED TOTAL(Rs.)

680.00

NET AMOUNT(Rs.) :

680.00

 

Account Head :

ROOK RENT

Bed No - Type:

6118 - SINGLE

Amount(Rs.). 3,000.00

(

SNo I

Bill No

Ser.Prov. 1

Dr Name

Service/Item

1 No's 1 Amount 1 Discount 1Total(Rs.)

3111 Status:

ACTIVE

1 S015053001499NA(SER02823) 31/05/2015 CHITWAN DUBEY

BED CHARGES

1

APPROVED TOTAL(Rs.) :

NET AMOUNT(Rs.) :

(

31/05/2015

(

Account Head :

PHARMACY

Bed No - Type:

6118 - SINGLE

31300.00

0.00

3,000.00

 

3,000.00

3,000.00

3,000.00

Amount(Rs ) 4,294.39

( SNo

BIll Status:

Bill No

ACTIVE

1

T1P1505270037(ZDT-2495)

2

T1P1505270106(14Y029KP)

3

T1P1505270080(15024308)

4

T1P1505270080(505103UJD1)

5

TIP1505270106(420-09015S)

6

T1P1505270309(E-189)

7

TIP1505270037(14AE21)

Ser.Prov.

1

Dr Name

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

Service/Item

MISOPROSTOL 200MCG TAB (TECTOR 200 TABN TAB( Exp. :11-2016)

METHERGIN 1ML INJ( Exp. :10-2016) STOPCOCK WITH EXTENSION LINE 10CM( Exp. :01-2018) SYRINGE WITH LUER LOCK 10CC,W/0 NEEDLE UNO LOK( Exp. :12-2019) PITOCIN INJ 0.5ML 10%0.5( Exp. :08-2016)

PROCTOCLYSIS ENEMA 100ML( Exp. :0E-

2016)

EPIDOSIN 1ML INJ( Exp. :11-2017)

1 No's1 Amount I Discount 1Total(Rs.) )

1

68.00

0.00

1

14.92

0.00

1

150.00

0.00

5

15.00

0.00

5

20.99

0.00

1

48.00

0.00

 

0.00

68.00

14.92

150.00

75.00

104.95

48.00

47.46

Note: All the Amounts are shown In Rupees

Service/Item Count

20

Page Total(Re.):

13,128

\\Pt age 2 of 5

If

I\

K/•

SevenHills

HO 3 Fl TAI.

Patient No: 1150527006

UHID:

MCH2400076 Patient Name:

IN-Patient Bill Breakup

ANANYA MOOKHERJEE Age(Sex): 30Y 5M OD ( F )

FinalBill No: BIPRI506010006 Bill Date:

01-06-2015

Sponsor:

VIPUL MEDCORP TPA

Pay Type: CREDIT

Account Head :

PHARMACY

Bed No - Type:

6118 SINGLE

Arneunt(Rs.) 4,294.39

t Pio

I

BIII No

I Ser.Prov.

Dr Name

BIII Status:

ACTIVE

8 T1P1505270037(GH50281)

27/05/2015

MEDICAL OFFICER

9 T1P1505270037(A14666)

27/05/2015

MEDICAL OFFICER

10 T1P1505270080(14102)

27/05/2015

MEDICAL OFFICER

11 T1P1505270598(9070477)

27/05/2015

MEDICAL OFFICER

12 T1P1505270037(MHE-464)

27/05/2015

MEDICAL OFFICER

13 TIP1505270037(9070462)

27/05/2015

MEDICAL OFFICER

14 TIP1505270037(3300915)

27/05/2015

MEDICAL OFFICER

15 TIP1505270080(141205)

27/05/2015

MEDICAL OFFICER

16 T1P1505270080(135515)

27/05/2015

MEDICAL OFFICER

17 TIP1505270080(N/A)

27/05/2015

MEDICAL OFFICER

18 TIP1505270080(1064)

27/05/2015

MEDICAL OFFICER

19 TIP1505270080(01)

27/05/2015

MEDICAL OFFICER

20 T1P1505270037(821D804810)

27/05/2015

MEDICAL OFFICER

21 T1P1505270037(IPMDA2501)

27/05/2015

MEDICAL OFFICER

22 T1P1505270598(NPA0060)

27/05/2015

MEDICAL OFFICER

23 TIP1505270080(140701)

27/05/2015

MEDICAL OFFICER

24 TLD1505270001(BB1414)

27/05/2015

MEDICAL OFFICER

25 T1P1505270037(1051573)

27/05/2015

MEDICAL OFFICER

26 T1P1505270037(E-189)

27/05/2015

MEDICAL OFFICER

27 T1P1505270080(4234270)

27/05/2015

MEDICAL OFFICER

28 T1P1505270080(22990)

27/05/2015

MEDICAL OFFICER

29 T1P1505270080(1501436)

27/05/2015

MEDICAL OFFICER

30 T1P1505270080(508055WS02)

27/05/2015

MEDICAL OFFICER

31 T1P1505270080(N15C092)

27/05/2015

MEDICAL OFFICER

32 TIP1505270037(51315015)

27/05/2015

MEDICAL OFFICER

33 T1P1505270080(RM14K078)

27/05/2015

MEDICAL OFFICER

34 T1P1505270080(141205)

27/05/2015

MEDICAL OFFICER

35 T1P1505270080(12551D)

27/05/2015

MEDICAL OFFICER

36 TIP1505270080(02511M)

27/05/2015

MEDICAL OFFICER

37 TIP1505270080(431016AG32)

27/05/2015

MEDICAL OFFICER

38 T1P1505270080(02563C)

27/05/2015

MEDICAL OFFICER

39 T1P1505270080(RM15D042)

27/05/2015

MEDICAL OFFICER

40 TIP1505270080(1505)

27/05/2015

MEDICAL OFFICER

41 T1P1505270080(1503463)

27/05/2015

MEDICAL OFFICER

42 T1P1505270080(507021W5F2)

27/05/2015

MEDICAL OFFICER

43 T1P1505270080(507052WS1-12)

27/05/2015

MEDICAL OFFICER

Service/Item

MISOPROST 25MCG TAB 1X4( Exp. :06-

2016)

RDOL 1ML INJ(TRAMADOL)( Exp. :11-

2016)

CATHETER FOLEYS, TWO WAY, 14 FR (RUSCFI)( Exp. :08-2019)

FORTWIN INJ 1X1ML( Exp. :12-2016)

DROTIN INJ 2ML( Exp. :11-2016)

FORTWIN INJ 1X1ML( Exp. :11-2016)

RINGER LACTATE VIAFLEX BAXTER 500ML( Exp. :06-2016) GLOVES SURGICAL, STERILE, SIZE-6( Exp. :11-2017) INJECTION NEEDLE 16G 1112 INCH( Exp.

:02-2020)

UNDER PAD(23*X36)( Exp. :05-2019)

SURGICAL BLADE, SIZE 23( Exp. :11-

2015)

APRON PLASTIC, DISP.( Exp. :02-2018)

NORMAL SALINE 09% 100ML(FRESINUS)( EXP. :03-2018)

KENADION 1MG/0.5ML INJ( Exp. :12-2016)

PHENERGAN 2ML INJ( Exp. :01-2018)

SHAVING SET, DISPOSABLE( Exp. :06-

2017)

PRIMIGYN 3GM GEL( Exp. :09-2016)

NORMAL SALINE 0.9% 5091iAL (NIRLIFE)( Exp. :02-2018) PROCTOCLYSIS ENEMA 100ML( Exp. :06-

2016)

I.V.CANNULA WITH WINGS AND INJECTION PORT 20G X 32MM, BD- VENFLOW PRO( Exp. 08-2017)

I.V.SET. ADULT, VENTED( Exp. :02-2019)

INFANT FEEDING TUBE 7( Exp. :12-2019)

SYRINGE 5CC, W/O NEEDLE DISPOVAN( Exp. :01-2020) URINE COLLECTION BAG, ADULT( Exp.

:02-2019)

BUSCOGAST 1ML INJ( Exp. :02-2017)

CORD CLAMP( Exp. :10-2018)

GLOVES SURGICAL, STERILE. SIZE-7( Exp. :11-2017) INJECTION NEEDLE 18G 11/2 INCH, DISPOVAN( Exp. :02-2020) INJECTION NEEDLE 26G 1 1/2 INCH, DISPOVAN( Exp. :11-2019) SYRINGE -ICC, W/O NEEDLE DISPOVAN( Exp. :07-2019) INJECTION NEEDLE 230 1 INCH, DISPOVAN( Exp. :12-2019)

OXYGEN MASK, ADULT( Exp. :03-2019)

SOLUS SWIFT UNDYED 2-0, 140CM 1/2 CRB, 1/2 CRC, 40MM - LNW 2777( Exp. :01

-2020)

SUCTION CATHETER 8(GS-2006)( Exp. :02

-2020)

SYRINGE 2CC, W/O NEEDLE DISPOVAN( Exp. :01-2020) SYRINGE 5CC. W/O NEEDLE DISPOVAN( Exp. :01-2020)

I No's j Amount I Discount I Totaglis.)

 

18.00

0.00

18.00

2

12.30

0.00

24.60

1

108.00

0.00

108.00

1

5.58

0.00

5.58

3

14.77

0.00

44.31

2

5.58

0.00

11.16

5

57.75

0.00

288.75

4

50.00

0.00

200.00

4

3.00

0.00

12.00

10

55.00

0.00

550.00

1

3.55

0.00

3.55

5

60.00

0.00

300.00

2

9.37

0.00

18.74

1

12.00

0.00

12.00

1

6.68

0.00

6.68

3

32.00

0.00

96.00

1

247.00

0.00

247.00

1

26.51

0.00

26.51

1

48.00

0.00

48.00

2

160.00

0.00

320.00

2

98.00

0.00

196.00

1

36.00

0.00

36.00

2

4.50

0.00

9.00

1

108.00

0.00

108.00

3

10.98

0.00

32.94

1

25.00

0.00

25.00

3

50.00

0.00

150.00

4

2.00

0.00

8.00

3

2.00

0.09

6.00

2

4.50

0.00

9.00

3

2.00

0.00

6.00

1

150.00

0.00

150.00

1

530.00

0.00

530.00

45.00

0.00

45.00

3

3.50_

0.00

10.50

4.50

dm

4.50

%Ye-

Note: NI the Amounts are Shown In Rupees

Seri/Ice/Item Count

36

Page Total(Rs.):

3,666.82

Page 3 of 5

SevenHills

ft OSPITA I.

IN-Patient Bill Breakup

Patient No: 1150527006

UHID:

MCH2400076 Patient Name:

ANANYA MOOKHERJEE Age(Sex): 30Y 5M OD ( F )

FinalBill No: BIPR1506010006 Bill Date:

01-06-2015

Sponsor:

Account Head :

PHARMACY

Bed No - Type:

SNo

I

Bill Status:

Bill No

ACTIVE

44 T1P1505270037(10N-622)

45 TIP1505270037(NPA0060)

46 TIP1505270080(141205)

47 TIP1505270080(150415)

t 27/05/2015

48 TIP1505310422(CFTB5B3)

31/05/2015

Bill Status:

PARTIAL RETURN

49 S1P1505280179(RM150042)

50 8IP1505280179(14102)

51 SIP1505280181(SB15015)

52 S1P1505280181(3300915)

53 SIP1505280181(1C51573)

54 51P1505280179(N15C092)

55 SIP1505280181(GH50281)

I Ser.Prov. I

Dr Name

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

27/05/2015

MEDICAL OFFICER

31/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

28/05/2015 MEDICAL OFFICER

VIPUL MEDCORP TPA

Pay Type: CREDIT

6118- SINGLE

Amount(Rs ). 4,294.39

Service/item

I Nee I Amount I Discount I Total(Rs.)

2

2

1

4

APPROVED TOTAL(Rs.) :

1

1

2

1

1

1

1

16.30

0.00

32.60

6.68

0.00

13.36

50.00

0.00

50.00

50.00

0.00

200.00

 

4,471.11)

313.50

0.00

313.50

 

313.50

4,784,61

150.00

0.00

150.00

108.00

0.00

108,00

10.98

0.00

21.96

57.75

0.00

57.75

26.51

0.00

26.51

108.00

0.00

108.00

18.00

0.00

18.00

ONDANSETRON 2ML INJ (ONDET 2ML INTAS)( Exp. :07-2016)

PHENERGAN 2ML INJ( Exp. :01-2018)

GLOVES SURGICAL, STERILE, SIZE-6( Exp. :12-2017) GLOVES SURGICAL, STERILE, SIZE-6.5(

Exp '03-2018)

CEFOPRIM 500MG TAB 1X4( Exp. :01-

2017)

OXYGEN MASK, ADULT( Exp. :03-2019)

CATHETER FOLEYS, TWO WAY, 14 FR (RUSCH)( Exp. :08-2019)

BUSCOGAST 1MLINJ( Exp. :02-2017)

RINGER LACTATE VIAFLEX BAXTER

500ML( Exp. :06-2016) NORMAL SALINE 0.9% 500ML (NIRLIFE)( Exp. :02-2018) URINE COLLECTION BAG, ADULT( Exp.

:02-2019)

MISOPROST 25MCG TAB 1X4( Exp. :06-

2010

28/05/2015

490.22

 

PARTIAL RETURN TOTAL(Rs.)

 

490.22

NET AMOUNT(Rs.) :

 

4,294.39

Account Head :

PACKAGES

Bed No - Type:

6118 - SINGLE

, Amount(Rs.)' 66,000.00

SNo I

SIII No

I Ser.Prov.

I

Dr Name

Service/Item

I No's I Amount I Discount I Total(Rs.)

BM Status:

ACTIVE

1

8015052900971NA(SER04099) 28/05/2015 CHITWAN DUBEY

VACCUM DELIVERY

 

1

66,000.00

0.00

66,000.00

28/05/2015

66,000.00

 

APPROVED TOTAL(Rs.) :

 

66,000.00

NET AMOUNT(Rs.) :

 

66,000.00

Account Head :

DIET

Bed No - Type:

6118- SINGLE

Amount(Rs.) 1,505.00

SNo I

Bill No

I

Ser.Prov.

I

Dr Name

Service/Item

I

No's I Amount I Discount I Total(Rs.)

13111 Status:

ACTIVE

1 8015052700742NA(SER04776)

27/05/2015 CI-IITWAN DUBEY

LUNCH

 

2 6015052700999NA(5ER05979)

27/05/2015 CHITWAN DUBEY

READYMADE COFFEE

t

27/05/2015

3 6015052900782NA(SER06016)

29/05/2015

CHITWAN DUBEY

PEPSI PET

4 8015052900411NA(SER05978)

29/05/2015

CHITWAN DUBEY

READYMADE TEA

5 8015052900782NA(SER04935)

29/05/2015

CHITWAN DUBEY

MISC-FOOD SERVICES

6 6015052901252NA(SER06032)

29/05/2015

CHITWAN DUBEY

RICE PLAIN

7 S015052900780NA(SER06033)

29/05/2015

CHITWAN DUBEY

FRIED RICE VEG

8 8015052900780NA(SER04935)

29/05/2015

CHITWAN DUBEY

MISC-FOOD SERVICES

29/05/2015

Note: All the Amounts are Show In Rupees

Service/Item Count

21

Page Total(Rs.):

250.00

0.00

250.00

49.00

0.00

49.00

 

299.00

66.00

0.00

66.00

22.00

0.00

22.00

120.00

0.00

120.00

62.00

0.00

62.00

103.00

0.00

103.00

1 >511011 0.00

150.00

66,941.

41,

BliteNvr:‘

it.

ast,

EE

4 of

523.00)

5

SevenHills

NORMAt

IN-Patient Bill Breakup

Patient No:

1150527006

FinalBill No:

BIPR1506010006

( Account Head :

DIET

SNo I

Bill No

Bill Status:

ACTIVE

UHID:

Bill Date:

MCH2400076

01-06-2015

Patient Name:

Sponsor:

Bed No - Type:

ANANYA MOOKHERJEE Age(Sex): 30Y 5M OD ( FEMALE )

VIPUL MEDCORP TPA

Pay Type: CREDIT

6118- SINGLE

Amount(Rs.): 1,505.00

Service/Item

I No's I Amount I Discount I Total(Rs.) )

 

40.00

0.00

40.00

120.00

0.00

120.00

22.00

0.00

22.00

103.00

0.00

103.00

150.00

0.00

150.00

66.00

0.00

66.00

 

501.00

 

22.00

0.00

22.00

40.00

0.00

40.00

120.00

0.00

120.00

 

182.00

APPROVED TOTAL(Re.) :

1,505.00

NET AMOUNT(Rs.) :

1,505.00

Ser.Prov. I

Dr Name

30/05/2015

CHITWAN DUBEY

30/05/2015

CHITWAN DUBEY

30/05/2015

CHITWAN DUBEY

30/05/2015

CHITWAN DUBEY

30/05/2015

CHITWAN DUBEY

30/05/2015

CHITWAN DUBEY

31/05/2015

CHITWAN DUBEY

31/05/2015

CHITWAN DUBEY

31/05/2015

CHITWAN DUBEY

9 S015053000416NA(SER04866)

10 S015053000879NA(SER04935)

11 S015053000359NA(SER05978)

12 5015053000879NA(SER06033)

13 5015053000882NA(SER04935)

14 S015053000879NA(SER06016)

IDLI SAMBER

MISC-FOOD SERVICES

READYMADE TEA

FRIED RICE VEG

MISC-FOOD SERVICES

PEPSI PET

30/05/2015

15 5015053100390NA(5ER05978)

16 5015053100390NA(5ER04866)

17 6015053100627NA(5ER04775)

•READYMADE TEA

IDLI SAMBER

LUNCH

I31/05/2015

Sno Account Head

Amount(Rs.)

1 DOCTOR CONSULTATION

6,550.00

2 REGISTRATION

240.00

3 MISCELLANEOUS GENERAL

170.00

4 PROCEDURES

8,940.00

5 LAB CHARGES

680.00

6 ROOM RENT

3,000.00

7 PHARMACY

4,294.39

8 PACKAGES

66,000.00

9 DIET

1,505.00

Billed Amount(Rs.):

91,379.39

Advance Amount:(-)

41,379.00

Total Amount(Rs.):

50,000.39

Round Amount(Rs.):

-0.39

Net Amount(Rs):

50,000.00

Net Payable In Words: (Rupees)FIfty Thousand only

Note: Ali the Amounts are Shown In Rupees

Service/item Count

9

Page Total(Rs.):

683.00

Page 5 of

5

I

r °.

SevenHills

HOSPITAL

In Address • 10 129 SO 155

UHID:

MCH2400076

Patient Name: ANANYA MOOKHERJEE

Doctor:

SWATI TEMKAR

SevenHills

Generated At • OP/WM 5 0947 SP1TAL GeneratedEly DCHHEOA

HGT Record

Calendar Date: All Calendars

Patient No:

1150527006

Age(Sex):

30Y 5M OD(F)

Bed No( LAD):

6118 (L6 B8 SINGLE ROOMS)

Admission Date: 27/05/2015 05:01

Dis Date:

01/06/2015 11:45

Sno

 

Date &Time

27/05/2015 05:15

1

AM

28/05/2015 06:05

2

AM

Bed No

3105 HOT- PROCEDURE CHARGE

Test Description

3108 HOT - PROCEDURE CHARGE

Result

UOM

Insulin

Entered By

90

mg/ell

MO